HIV/AIDS has been the scourge of Sub-Saharan Africa for nearly three decades. Millions of foreign aid dollars have been spent to prevent the epidemic's spread, mainly by encouraging behaviour change among individuals in areas with high prevalence. However, these policies have not done as much to curb the epidemic as one might hope. In order to assess why, Esacove uncovers ‘the Story of HIV/AIDS’ emerging from three disparate data sources, each of which produces a ‘master’ narrative – the ‘official’ (drawn from policy documents), the ‘industry’ (outlined by NGO and government employees in Malawi) and the ‘everyday’ (developed from ethnographic journals kept by rural Malawians about the conversations about HIV that they hear and take part in). She adeptly shows a very real gap between policy rhetoric (which everyone can and does repeat) and reality on the ground, with a particularly critical and keen eye toward ways gender crops up in problematic ways. She identifies three fatal flaws of US-based African HIV policy: (1) the misconception that ‘modernity and heteronormativity … hold inherent protective powers against a virus' (p. 133), (2) that gender is used as a proxy for women, and (3) that prevention strategies ignore sex.

In Esacove's reading, the ‘official’ and ‘industry’ policy prescriptions essentially state that Africans must leave behind their backward traditional ways and become modern neoliberal subjects. These notions, dependent largely on a gendered discourse, but really focused on women changing their behaviour and response to sexual advances (by eschewing sex), put the impetus on individual actors, largely ignoring the need for structural change. Thus, Escavone points out as she presents policy interventions and reviews realms of recommendations (e.g. women's economic empowerment, women's legal rights and protection) focus on changing individuals’ behaviour rather than upending social structures.

Each body chapter outlines one of the three primary narratives, but also explains the fit with the other two sources. This organisational style leads to repeated referencing of previous and next chapters; while necessary to show the differences across narratives, this directorial sign-posting is often distracting. The strongest writing is the analysis of the ‘everyday’ narrative from the ethnographic journals. More than being just readable and interesting, these sections provide insight into the reasons for the gap between the narrative on the ground and the other two narratives. It highlights: (a) the perspective of those navigating the reality of HIV, and (b) the need to reframe policy around actual lived experience rather than policy workers’ imagined one. While all three narratives share the declared importance of knowledge and skills, they diverge in terms of the prescribed prevention pathways. The ‘official’ and ‘industry’ prescriptions mainly focus on eliminating risk of HIV infection entirely. However, the ‘everyday’ narrative concentrates on a more viable concept: risk reduction through strategies that allow individuals to make more informed choices in selecting sexual partners (rather than relying on abstinence or condoms).

One drawback is that the book was written at the cusp of antiretroviral (ART) rollout in Malawi, such that Esacove can only hint at the implications ART might have for HIV prevention, and notably for ‘everyday’ strategies that may be thwarted when people living with HIV on ART ‘look healthy’. Continued research and critical reflection exposing narrative gaps are necessary to move toward more locally driven (and acceptable) policy recommendations, particularly as ART rollout shifts both aims of HIV policymakers and the realities on the ground.